Evaluation of cardiac functions during and after acute febrile neutropenic attack in patients with pediatric malignancies

Febrile attacks of neutropenia (FNA), infections and sepsis are the most common complications in children with malignancy, especially after the application of intensive chemotherapy protocols. In our study, we investigated whether there was cardiac dysfunction during FNA. Our study included 36 episodes of febrile neutropenia (41.7% (n=15) female and 58.3% (n=21) male). Systolic and diastolic cardiac functions were measured by 2-dimensional, M mode, tissue Doppler and pulsed-wave echocardiography (ECHO) on the 1st and 7th days of the attack. Relationships between ECHO parameters with inflammation markers (CRP, procalcitonin) and cardiac biomarkers (Troponin T, CK-MB, NT-proBNP) that measured on the 1st, 3rd and 7th days were investigated. As diastolic dysfunction parameters, transtricuspid A (from 54.60±12.38 cm/sec to 48.46±11.97 cm/sec) and transmitral A (from 67.76±16.73 cm/s to 59.58 ± 12.58 cm/sec) velocities and tricuspid annulus A' velocity (14.53±6.87 cm/sec to 11.07±4.09 cm/sec) were observed that it regressed significantly from day 1 to day 7 (p<0.05). In the group whose neutropenic fever lasted less than 48 hours, the mitral annulus E/E' ratio (5.77 ± 1.23) on the 1st day was found to be significantly lower than the group that lasted longer than 48 hours (6.82 ± 1.79) (p< 0.05). With the CRP value in the first 24 hours; there was a significant negative correlation between Mitral A', Septal E', Septal A' and Septal S velocities. On the third day, a significant positive correlation was found between CRP and procalcitonin levels and NT-proBNP levels. In conclusion, it was determined that our echocardiographic findings, especially in the first 24 hours, when fever and inflammation are intense in FNA, indicate the presence of impaired relaxation, which is the early stage of diastolic dysfunction. It was thought that NT-proBNP levels might reflect this diastolic effect as a laboratory finding.